Strategies for Success in Total Joints

More than one million joint replacements are performed each year and increasing numbers of surgeons are opting to do them with the benefit of robotic assistance. I’ve been in practice for over 10 years and recently launched the robotics program at Montefiore Medical Center in the Bronx — a move made in response to market pressure and to provide cutting-edge care. It’s essential to remain at the forefront of orthopedic offerings to advance hip and knee replacement surgery, especially when your facility will capture more cases and provide patients with improved outcomes. 

Most orthopedic surgical robots on the market have a large mechanical arm that resembles robotic arms used in automated manufacturing plants. Sensors are attached with small pins to bones around the joint that’s being replaced. During a hip replacement, for example, pins are attached to the pelvis and femur. Those pins tell the robot where the bones are located and where cuts need to be made. The robot can identify exact angles of cuts that need to be corrected in real time, a feature that is very helpful in placing implants more precisely in patients who are obese or have joint deformities. There is a higher risk of malpositioned implants during conventional surgery in these patients, so the robot allows for more accuracy and precision. Setting up the robot adds a couple minutes to the surgery, but once the pins are attached, the calculations are essentially instantaneous.

Although the robot helps me place standard implants precisely and accurately, I can also use custom implants based on 3D models of a patient’s specific anatomy. Pre-op CT scans of the patient’s leg and joint are sent to the manufacturer of the implants. In five to six weeks, we receive the 3D-printed customized implant and the custom tools with which to implant it. The tools arrive in a single tray, which cuts down on the number of instruments scrub techs need to manage and reprocessing techs need to clean and sterilize.

I recently took care of a young patient who had suffered a knee fracture, which caused deformity in the joint, from falling off a ladder. He couldn’t bend his knee or play with his kids, the things we take for granted when we’re healthy. I replaced his knee using the robot and the joint’s motion improved just a few weeks after surgery. The patient had six plates and screws in and around his knee because of the injury, and the custom-made implants helped me work around the existing hardware without a significant amount of dissection.

The use of customized implants improves workflow in the OR, doesn’t add time to procedures or impact outcomes — in fact, we see a trend toward less intraoperative bleeding. Revision surgeries are needed after 1% to 2% of traditional total hip and knee replacements, and patients are dissatisfied with the outcomes of non-robotic joint replacements 10% to 15% of the time. These figures suggest the increased accuracy afforded by robotics could lead to better outcomes and improved patient satisfaction. Although there is no specific data on increased success rates with the technology, in the long term it may result in fewer revisions needing to be performed.